This report, produced by authors at ODI and the Center for Global Development (CGD), analyses the intersection between the older persons’ care sector and migration. It looks at the experience of migrant workers and the patterns of mobility for older persons’ care between countries. It also provides three case studies – China, the United Kingdom (UK) and the United States (US) – to better understand how governments have sought to support older persons’ care systems and address workforce challenges.

The report concludes with recommendations to policy-makers in high-income, rapidly ageing countries that are struggling with these issues.

Key messages:

• Many high-income countries are facing a rapidly increasing demand for older persons’ care, alongside huge workforce shortages. Workforce shortages are directly linked to the sector’s low pay, poor working conditions and the undervalued nature of care work. These stem from the feminisation of care work, including paid employment, and the impact of more recent austerity, privatisation and marketisation trends.
• Migrants are essential to the delivery of older persons’ care in many high-income countries, often filling gaps left by inadequate formal care systems. They also help to make care affordable for those who would otherwise go without support. However, they are more likely than local workers to encounter low pay and poor working conditions, particularly if working in home care, and if undocumented.
• Few examples of labour migration pathways exist that bring in sufficient numbers of older persons’ care workers who are able to work under fair employment conditions. Where pathways have been used, careful design is required to guard against the exploitation of these workers and to ensure continuity of care.
• Countries need to make the sector more attractive to local workers. However, recruiting migrant workers appears to be the only way to provide safe and high-quality care for older people, both now and in the medium-term as countries age rapidly. Ensuring ethical and sustainable international recruitment should be an immediate policy priority.